The Incentive for “Imaging based cancer patient’ management”

Author and Curator: Dror Nir, PhD

It is generally agreed by radiologists and oncologists that in order to provide a comprehensive work-flow that complies with the principles of personalized medicine, future cancer patients’ management will heavily rely on “smart imaging” applications. These could be accompanied by highly sensitive and specific bio-markers, which are expected to be delivered by pharmaceutical companies in the upcoming decade. In the context of this post, smart imaging refers to imaging systems that are enhanced with tissue characterization and computerized image interpretation applications. It is expected that such systems will enable gathering of comprehensive clinical information on cancer tumors, such as location, size and rate of growth.

What is the main incentive for promoting cancer patients’ management based on smart imaging?

It promises to enable personalized cancer patient management by providing the medical practitioner with a non-invasive and non-destructive tool to detect, stage and follow up cancer tumors in a standardized and reproducible manner. Furthermore, applying smart imaging that provides valuable disease-related information throughout the management pathway of cancer patient will eventually result in reducing the growing burden of health-care costs related to cancer patients’ treatment.

Let’s briefly review the segments that are common to all cancer patients’ pathway: screening, treatment and costs.

Screening for cancer:It is well known that one of the important factors in cancer treatment success is the specific disease staging. Often this is dependent on when the patient is diagnosed as a cancer patient. In order to detect cancer as early as possible, i.e. before any symptoms appear, leaders in cancer patients’ management came up with the idea of screening. To date, two screening programs are the most spoken of: the “officially approved and budgeted” breast cancer screening; and the unofficial, but still extremely costly, prostate cancer screening. After 20 years of practice, both are causing serious controversies:

In trend analysis of WHO mortality data base [1], the authors, Autier P, Boniol M, Gavin A and Vatten LJ, argue that breast cancer mortality in neighboring European countries with different levels of screening but similar access to treatment is the same: “The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality”.

In prostate cancer mortality at 11 years of follow-up [2], the authors,Schröder FH et. al. argue regarding prostate cancer patients’ overdiagnosis and overtreatment: “To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected”.

The lobbying campaign (see picture below) that AdmeTech (http://www.admetech.org/) is conducting in order to raise the USA administration’s awareness and get funding to improve prostate cancer treatment is a tribute to patients’ and practitioners’ frustration.

Treatment: Current state of the art in oncology is characterized by a shift in the decision-making process from an evidence-based guidelines approach toward personalized medicine. Information gathered from large clinical trials with regard to individual biological cancer characteristics leads to a more comprehensive understanding of cancer.

Quoting from the National cancer institute (http://www.cancer.gov/) website: “Advances accrued over the past decade of cancer research have fundamentally changed the conversations that Americans can have about cancer. Although many still think of a single disease affecting different parts of the body, research tells us through new tools and technologies, massive computing power, and new insights from other fields that cancer is, in fact, a collection of many diseases whose ultimate number, causes, and treatment represent a challenging biomedical puzzle. Yet cancer’s complexity also provides a range of opportunities to confront its many incarnations”.

Health-care economics: We are living in an era where life expectancy is increasing while national treasuries are over their limits in supporting health care costs. In the USA, of the nation’s 10 most expensive medical conditions, cancer has the highest cost per person. The total cost of treating cancer in the U.S. rose from about $95.5 billion in 2000 to $124.6 billion in 2010, the National Cancer Institute (www.camcer.gov) estimates. The true sum is probably higher as this estimate is based on average costs from 2001-2006, before many expensive treatments came out; quoting from www.usatoday.com : “new drugs often cost $100,000 or more a year. Patients are being put on them sooner in the course of their illness and for a longer time, sometimes for the rest of their lives.”

With such high costs at stake, solutions to reduce the overall cost of cancer patients’ management should be considered. My experience is that introducing smart imaging applications into routine use could contribute to significant savings in the overall cost of cancer patients’ management, by enabling personalized treatment choice and timely monitoring of tumors’ response to treatment.

15 Responses

Dr. Nir,
Thank you for your first post. Your area of expertise, medical imaging and patient management using imaging technologies is one of the most important fields that is a health cost lever one of the very that will bring health cost down FAST.

I’ll request all EAW to connect your post to their Groups on LinkedIn, I assume that you did that, I will do it as well.

I am thrilled to have you join our Team. Your Field of Expertise is a very significant addition to our Research Category System (RCS) which represents one of the three components for valuation of the venture:
(a) RCS – Original 23 categories vs. Current 65 categories to represent Frontiers of Science
(b) Collection of CVs and active EAW
(c) http://www.Traackr.com evaluation of the online Influence/relevance based on hits and the 2nd re-tweets, new citations, repeat visits.

Great Job. I am looking forward to learn by reading your posts.

Please consider to have posts on
– new usage of CT for Minimally Invasive Surgery
– Imaging of Brain tumors and interventions using imaging

In regards to your observations above; indeed, overtreatment and related morbidity and costs is one of our health care system’s worst phenomena. I agree that in an ideal world, using imaging should be complementary to bio-markers signals and a step before any intervention.

Dr. Nir,
We are on the same page, I mentioned the genomic RNA for diagnostics to prevent PCI if possible as another tool to supplement and compliment imaging. Any PCI or CABG subject the patient to life long drug treatment with Plavix and/or Coumadin – very high cost regimen due to Labs follow up and MD drug dose adjustments.

Great to have you with my own Team. My Shoulders suddenly feel wider, you are a strong resource to bounce on all my mini to grand visions.

Yes, it is a very interesting time if this question can be answered: is Cancer Cell a cause of cancer or it is only a symptom? If it is only a symptom (my point of view) any diagnostic, screening, treatment efforts focused on cancer cell is a wasting of time!